Endometrial Hyperplasia: Causes, Symptoms and Treatment

Table of contents 

• What is endometrial hyperplasia? 

• Types of endometrial hyperplasia 

• Causes of endometrial hyperplasia 

• Risk factors for endometrial hyperplasia 

• Symptoms of endometrial hyperplasia 

• Diagnosis of endometrial hyperplasia 

• Treatment of endometrial hyperplasia 

• When to consult a doctor? 

• Complications of endometrial hyperplasia 

• Prevention of endometrial hyperplasia 

• Take home points

• FAQ on Endometrial Hyperplasia

Introduction 

Women's health issues can be complex and often require specialized attention. Many women suffer from a painful condition, known as endometrial hyperplasia, which can have a substantial negative influence on their quality of life. It occurs when the lining of the uterus, known as the endometrium, becomes too thick, potentially leading to abnormal menstrual bleeding or even the development of cancer.

Everything you need to know about endometrial hyperplasia, including its causes, symptoms, and treatment options, will be covered in this article. Additionally, we'll offer some advice on how to avoid it altogether. Keep reading if you want to learn more or if you're having symptoms! You'll have all the information you need to make knowledgeable health decisions by the time you finish reading this article. 

What is endometrial hyperplasia?

Endometrial hyperplasia is a condition in which the lining of the uterus, known as the endometrium, becomes too thick. The endometrium changes throughout the menstrual cycle in response to hormones. 

During the first part of the cycle, the hormone estrogen causes the endometrium to grow and thicken to prepare the uterus for pregnancy. In the middle of the cycle, an egg is released from one of the ovaries (ovulation). If the egg is not fertilized, the hormone progesterone causes the endometrium to shed and menstruation to occur.

In endometrial hyperplasia, the endometrium continues to grow and thicken even after ovulation has occurred. This can lead to a number of problems, including:

• Heavy menstrual bleeding

• Irregular menstrual bleeding

• Postmenopausal bleeding

• Anemia

• Endometrial cancer

Even though endometrial hyperplasia is not a malignancy, if left untreated, it can occasionally develop into endometrial cancer. 

Types of endometrial hyperplasia 

Endometrial hyperplasia can be divided into four primary categories depending on how the endometrium's cells look under a microscope:

• Simple hyperplasia without atypia: The uterine lining thickens more than usual in simple hyperplasia without atypia, which is the mildest type of endometrial hyperplasia. Cells in this condition look normal rather than abnormal.

• Complex hyperplasia without atypia: The endometrial cells in this type of complex hyperplasia without atypia are more packed and disorganized than in simple hyperplasia, but they still do not exhibit any abnormalities.

• Simple hyperplasia with atypia: This type raises more red flags than simple hyperplasia without atypia due to the endometrial cells' apparent abnormality or "atypical" appearance. Even though this variety is not yet malignant, if untreated, it can develop into cancer.

• Complex hyperplasia with atypia: The most serious type of endometrial hyperplasia is complex hyperplasia with atypia, in which the endometrial cells exhibit both disorganization and abnormality. If ignored, this condition has a higher risk of progressing to endometrial cancer.

Causes of endometrial hyperplasia

Progesterone and estrogen hormone imbalance is the most frequent cause of endometrial hyperplasia. The endometrium grows with the aid of the hormone estrogen. A hormone called progesterone aids in the endometrium's shedding. The endometrium can get excessively thick when there is too much oestrogen present and not enough progesterone.The following are additional elements that could raise the risk of endometrial hyperplasia:

• Obesity

• Polycystic ovary syndrome (PCOS)

• Diabetes

• Taking estrogen therapy

• Not having children

• Early menopause

• Family history of endometrial cancer

Risk factors for endometrial hyperplasia

Endometrial hyperplasia is more common in women who are going through menopause or perimenopause. Rarely does it affect those under the age of 35. Other danger signs consist of:

• Treatments for breast cancer (tamoxifen).

• Diabetes.

• Late onset of menopause or early menstruation.

• Ovarian, uterine, or colon cancer in the family.

• Gallbladder disease.

• Estrogen-only hormone therapy when a uterus is still present.

• Nulliparity

• Obesity.

• PCOS, or polycystic ovarian syndrome.

• Smoking tobacco.

• Thyroid disorder.

• Long history of menstrual irregularities or absence.

• History of pelvic irradiation (exposure to radiation).

• Compromised immune system as a result of medication or autoimmune illness.

Symptoms of endometrial hyperplasia

Depending on the kind and severity of the illness, endometrial hyperplasia can present with a variety of symptoms. While some women with endometrial hyperplasia may not have any symptoms, others may experience other symptoms such as significant abnormalities in their menstrual periods. The following are some typical signs of endometrial hyperplasia:

• Abnormal menstrual bleeding: The most prevalent sign of endometrial hyperplasia is abnormal uterine bleeding, which can appear as severe or prolonged menstrual bleeding, irregular periods, or bleeding in between periods.

• Short menstrual cycles: Some women suffering from endometrial hyperplasia also complain of short menstrual cycles, i.e. cycle shorter than 21 days length.

• Pelvic pain: Endometrial hyperplasia patients may suffer mild to severe pelvic pressure or pain, which can range in intensity.

• Vaginal discharge that is abnormal: Some women with endometrial hyperplasia may experience an odd or unpleasant-smelling vaginal discharge.

• Infertility: Endometrial hyperplasia can occasionally decrease fertility and make it challenging for women to get pregnant.

• Anemia: Endometrial hyperplasia-related heavy or protracted bleeding can cause anemia, a condition in which the body's supply of red blood cells is inadequate

• Bleeding after menopause

• Amenorrhea i.e. not having a period at all

• Dyspareunia: It’s possible that endometrial hyperplasia can cause abdominal/pelvic pain or pain during intercourse. Though this is not common. 

Diagnosis of endometrial hyperplasia 

Your physician will most likely perform a pelvic exam if you exhibit any endometrial hyperplasia symptoms. Your doctor will place two fingers into your vagina during a pelvic exam to feel your uterus and ovaries.

One or more of the following tests may be requested by your doctor in order to determine the source of your symptoms:

• Transvaginal ultrasound: This procedure creates images of your uterus using sound waves. When your uterine lining is overly thick, the photos can reveal this.

• Endometrial biopsy: Endometrial biopsies involve the removal of tissue samples from the uterine lining. Pathologists examine the cells under a microscope to see whether cancer is present or not.

• Hysteroscopy: To inspect your cervix and see inside your uterus, your doctor will use a thin, illuminated instrument known as a hysteroscope. This operation could be carried out in conjunction with a biopsy or a dilation and curettage (D&C). Your doctor can use hysteroscopy to examine the endometrial cavity for abnormalities and obtain a biopsy of any suspect regions.

Treatment of endometrial hyperplasia 

Progesterone is typically used as a treatment for endometrial hyperplasia. Progesterone, a hormone your body lacks, is synthesized by humans as progestin. Multiple types of progesterone exist:

• Birth control pills

• Progesterone therapy

• Endometrial ablation

• Vaginal cream and gels 

• Intrauterine device

• Hysterectomy - If you are postmenopausal, your doctor will likely recommend a hysterectomy. Hysterectomy is the surgical removal of the uterus.

When to consult a doctor? 

You should consult your healthcare provider if you experience:

• Heavy or abnormal bleeding.

• Vaginal bleeding after menopause.

• Painful cramping during menstruation (dysmenorrhea).

• Painful urination (dysuria).

• Painful intercourse (dyspareunia).

• Pelvic pain.

• Unusual vaginal discharge.

• Frequently missed menstrual periods.

Complications of endometrial hyperplasia 

Endometrial cancer risk can rise if endometrial hyperplasia is left untreated. One type of cancer that develops in the uterine lining is endometrial cancer. The majority of women develop this sort of cancer.

Prevention of endometrial hyperplasia 

There is no sure way to prevent endometrial hyperplasia. However, there are some things you can do to lower your risk, such as:

• Maintain a healthy weight

• Exercise regularly

• Eat a healthy diet

• Don't smoke

• Limit alcohol intake

• Take hormone therapy only as needed

• Have regular pelvic exams

If you are concerned about endometrial hyperplasia, talk to your doctor.

Take home points

Endometrial hyperplasia is a common gynecological disorder that, if neglected, can develop into endometrial cancer. It is crucial to speak with your healthcare professional and receive a diagnosis and treatment plan if you are showing any signs of endometrial hyperplasia.